ESA Doses Lower Among Dialysis Patients at Higher Elevations

BOSTON—Doses of erythropoiesis-stimulating agents (ESAs) are lower among anemic hemodialysis (HD) patients living at higher elevations, new findings suggest that are presented at the National Kidney Foundation's 2016 Spring Clinical Meetings.

It remains unclear, however, whether decreased ESA dosing at higher elevations are attributable to increased endogenous production of erythropoietin or increased ESA responsiveness.

Yue Jiao, PhD, of Fresenius Medical Care North America (FMCNA), and colleagues analyzed ESA dosing data from 98,303 patients on chronic HD receiving care at FMCNA in-center dialysis facilities from June 1 to August 31 of 2015. They used data from the U.S. Geological Survey to determine patients' elevation of residence.

Results showed that ESA doses decreased with increasing elevation. For example, HD patients at sea level had a normalized mean ESA dose of about 0.1, whereas patients living at 1,000 meters (3,281 feet) or 2,000 meters (6,562 feet) had a normalized mean ESA dose of about −0.08 and −0.25, respectively.

“The most notable findings are that differences in the geography of residence can affect the treatment of end-stage renal disease patients,” Dr. Jiao told Renal & Urology News. “In this case, we found that the required dosing of erythropoietin-stimulating agents decreases as the elevation of residence increases in chronic hemodialysis patients. Overall, this suggests that care models for end-stage renal disease patients should take geography and elevation into consideration.”